Adrenal gland disorders

• 1.ADRENAL GLANDDISORDERS

2. INTRODUCTION Each person has 2 adrenal glands 2 separate glands with independent function Hypofunction and hyperfunction of adrenal cortex 3. REVIEW OF ANATOMY AND PHYSIOLOGYAdrenal glandCortexmedulla 4. Adrenal cortexGlucocorticoids mineralocorticoids sexHydro cortisone corticosterone 5. Medullaa. Epinephrineb. nor epineprine 6. ADISSONS DISEASEDEFINITION:Inadequate secretion of ATCHfrom pitutary gland resultsadrenal in sufficiency . Primaryadrenal insufficiency resultsfrom idiopathic atropy ordestruction of adrenal glandsby autoimmune process. 7. ETIOLOGY AND RISK FACTORS Tuberculosis (TB) :TB is an infection whichusually affects the lungs. In some cases theinfection can spread to, and graduallydestroy, the adrenals Other infections can sometimes affectboth adrenals. Cancers of other parts of the body canspread and destroy the adrenals. Rare hereditary conditions. adrenalectomy Auto immune diseases: auto-immunediseases the immune system makesantibodies against part or parts of thebody. In auto-immune Addisons disease,you make antibodies which attach to cellsin the adrenal cortex 8. CLINICAL MANIFESTATION General weakness and becoming easily tired. Darkened areas of skin (pigmentation). Blood pressure is low and falls further whenyou stand which can make you dizzy. Being off your food and weight loss. Feeling sick and vomiting from time to time. Abdominal pains which may come and go. Diarrhoea or constipation which may come andgo. Cramps and pains in muscles. Craving for salt, or salty foods and drinks. Menstrual periods in women may becomeirregular, or stop. 9. DIAGNOSTIC TESTS Serum electrolyte levels Blood glucose levels CBC X ray studies Computed tomography MRI 10. TREATMENT Cortisol replacement You need steroid medication to replace the cortisolwhich you no longer make. This is usually with amedicine called hydrocortisone which is very similar tocortisol. The amount is usually about 15-25 mg eachday. Some people need more than this, and others less.The daily amount is broken up into two or three doseseach day with a higher dose taken in the morning thanin the evening. For example, you may be advised totake 15 mg in the morning and 10 mg early evening. 11. Replacing aldosteroneFludrocortisone is a substitute medicine foraldosterone. This helps to regulate bloodpressure and blood salt level. You may also beadvised to take extra salt each day. Addisonian crisis This is a medical emergency. You will be givenhydrocortisone injections, a drip of fluid to bringup your blood pressure, and may need intensivecare until the crisis is over. then need to continuetaking hydrocortisone medication 12. CUSHING SYNDROME DEFINITION:. Cushings syndrome developswhen the level of a glucocorticoid in yourbody is too high over a long period of time.Too much glucocorticoid can occur from anexogenous or endogenous source 13. ETIOLOGY Adrenal hyperplasia - which means there isincreased number and growth of the cells inthe adrenal glands. These cells then make toomuch cortisol. There are various differenttypes of adrenal hyperplasia. A benign (noncancerous) tumour of anadrenal gland. A malignant (cancerous) tumour of an adrenalgland 14. SIGNS AND SYMPTOMS Obesity - Facial puffiness, and the face often looks redderthan usual. Diabetes. Facial hair in women. High blood pressure. Muscle weakness. Thin skin which bruises easily. Purple/pink stretch marks Tiredness. Aches and pains - particularly backache. Mood swings - such as being more irritable,depressed, or anxious than usual. Lack of sex drive (libido). Periods may become irregular, or stop, inwomen. Osteoporosis . You may fracture a bone moreeasily than usual. Oedema around the ankles. 15. DIAGNOSTIC TESTS Serum cortisol levels Salivary cortisol levels ACTH Level ACTH Test Pituitary MRI 16. TREATMENT Radiotherapy to the pituitary gland can destroy the pituitaryadenoma. This has a good chance of success, but may take monthsor years to take effect. Medication (see below) may be needed untilthe radiation treatment takes effect. Also, the radiotherapy maydamage the normal pituitary cells, and may cause low levels ofother hormones made by the pituitary gland. However,replacement hormone therapy can usually be taken if this occurs. Surgery to remove both adrenal glands is an option. This stops yourbody making any cortisol (and other hormones) from your adrenalglands. You will need lifelong replacement therapy of certainhormones. However, the adenoma will remain in the pituitary andcontinue to produce high levels of ACTH which can cause problemsin some cases. Medication to block the production or effects of cortisol may work.There are several medicines which can be tried with various levelsof success. 17. PHEOCHROMACYTOMADEFINITION:Pheochromacytoma is a catecholaminesecreting tumor of the cromaffin cells of thesympathetic nervous system it is usually foundin the adrenal medulla. 18. SYMPTOMS Abdominal pain Chest pain Irritability Nervousness Pallor Palpitations Rapid heart rate Severe headache Sweating Weight loss 19. DIAGNOSTIC TESTS Abdominal CT scan Adrenal biopsy Catecholamines blood test Glucose test Metanephrine blood test MIBG scintiscan MRI of abdomen Urine catecholamines 20. TREATMENT Treatment involves removing the tumor with surgery. Itis important to stabilize blood pressure and pulse withmedication before surgery. close monitoring of vitalsigns. After surgery, it is necessary to continually monitor allvital signs in an intensive care unit. When the tumorcannot be surgically removed, medication is needed tomanage it. This usually requires a combination ofmedications to control the effects of the excessivehormones. Radiation therapy and chemotherapy havenot been effective in curing this kind of tumor. 21. NURSING MANAGEMENT Risk for injury related to weakness Risk for infection related to altered proteinmetabolism Self care deficit related to fatigue and musclewasting Altered body image related to tunical obesity 22. Corticotropin-Releasing Factor Test in Normal Subjects and Patients with Hypothalamic-Pituitary-Adrenal Disorders* Corticotropin-releasing factor (CRF) tests were performed in normal subjects andpatients with hypothalamicpituitary-adrenal disorders. In normal subjects, after ivadministation of 500 g synthetic ovine CRF, plasma ACTH rose significantly toapproximately 3.6 times the basal level at 3060 min and cortisol reached a peakof 2.3 times the basal level at 6090 min, whereas aldosterone peaked at 1.6 timesthe basal level at 60 min. Injection of 100 g CRF in normal subjects also caused asignificant increase in plasma ACTH and cortisol levels but only a slight increase inaldosterone. However, the total hormone released and their peak levels werelower than those elicited by the 500-g dosage. In patients with Cushings disease,although the basal and peak levels of plasma ACTH and cortisol induced byadministration of CRF were variable, the ratios of increase for the two hormoneselicited by CRF were lower than those in normal subjects, especially for cortisol. Inpatients with Cushings syndrome due to an adrenal adenoma, basal levels ofACTH were markedly suppressed and plasma ACTH and cortisol did not rise afterCRF. In patients with isolated ACTH deficiency or Sheehans syndrome the basallevel of plasma ACTH was less than 5 pg/ml and no change in plasma ACTHoccurred after injection of CRF. In patients with Nelsons syndrome or Addisonsdisease the basal levels of ACTH were extremely elevated but infusion of CRFincreased plasma ACTH to even higher levels. 23. presented by, samantha14/4/2012